Satisfaction with medical care during pregnancy and delivery

Societal attitudes toward the medical profession are apparently undergoing a change from awe and total respect to a more critical assessing of accountability and credibility. Based on mass media reports and the increasing number of malpractice suits, it would appear that a rational, unbiased review of medical doctors, hospital personnel, and care received is in order. This review should be concerned with technical aspects of medicine as determined by highly competent professionals and the consumer's view of the medical care he receives. The latter review should logically be taken directly to the consumers of medical care to determine their satisfaction with the care they received. Because of the varied areas of specialty within the medical profession, there are different types of relationships between doctors and their patients. The obstetrician, for instance, is usually associated with pregnancy as a joyful event, in contrast to a surgeon whose diagnosis may seldom be accompanied by joy. Satisfaction with medical care could thus be expected to vary according to the area of specialty and may be related to factors over which doctors have no control, factors which initially bring the patient to the doctor for care. The degree of anxiety related to the patient's condition could also be expected to contribute to the degree of satisfaction expressed by the patient.     

A comparison of parameters used to assess liver damage in sheep treated with carbon tetrachloride

Changes in serum enzyme levels, liver histology and liver function tests have been correlated to determine the usefulness of these tests in assessing liver status. The effects of carbon tetrachloride administration on these parameters has been determined in a group of 20 sheep. Normal levels, elevated levels after injury and the effect of elapsed time after injury are reported for serum glutamic dehydrogenase, sorbitol dehydrogenase, glutamic-oxaloacetic transaminase, glutamic-pyruvic transaminase, lactate dehydrogenase, fructose-1-phosphate adlolase, alkaline phosphatase, cholesterol and proteins. Variation in the time of elevation of enzyme activities may be useful in determining the elapsed time between acute injury and serum sampling. In comparison to sheep fed an adequate diet, a diet with a restricted protein intake was associated with increased severity of histological lesions and decreased liver function.     

Synovitis in internal derangement of the temporomandibular joint: correlation between arthroscopic and histologic findings

PURPOSE: To define arthroscopic criteria for synovitis (SYN) reflecting specific histologic changes. Arthroscopic observations in the temporomandibular joint of patients with internal derangement were compared with histologic patterns in synovial biopsies obtained during arthroscopy. PATIENTS AND METHODS: Arthroscopic biopsies were obtained in 31 joints of 31 patients using an oriented semiblind technique. The histologic changes in the biopsies were compared with those in age-matched reference material obtained at autopsy. RESULTS: Microscopic examination of the reference material showed inflammation in three specimens (18%), whereas it showed inflammation in 22 patient specimens (71%). Biopsies from the patients also exhibited more pronounced inflammation. According to conventional criteria, arthroscopy showed mild SYN (increased vascularity) in 51%, moderate changes in 39%, and more pronounced changes in 10% of the joints. The presence of moderate or pronounced arthroscopic signs of SYN (capillary hyperemia and synovial hyperplasia), correlated well with the histologic diagnosis of SYN. This was in contrast to patients with mild arthroscopic SYN (increased vascularity). CONCLUSION: Increased vascularity seen during arthroscopy must be questioned as a sign of SYN. More reliable criteria seem to be capillary hyperemia and synovial hyperplasia.     

Mechanism of p-nitrosophenol reduction catalyzed by horse liver and human pi-alcohol dehydrogenase (ADH). Human pi-ADH as a quinone reductase

The mechanism of reduction of p-nitrosophenol (pNSP) catalyzed by horse liver alcohol dehydrogenase (HADH) and human pi-alcohol dehydrogenase (pi-ADH) has been compared in transient and steady-state experiments. Our results indicate that pNSP reduction catalyzed by these two ADH proceeds by different mechanisms. In one mechanism, shown by Equation 1, pNSP is reduced to p-aminophenol (pAP) via two enzymatic steps (Steps 1 and 3), which are mediated by the nonenzymatic dehydration of p-N-hydroxyaminophenol (pN-OHAP) to 1,4-benzoquinoneimine (BQI) (Step 2). [formula: see text] Pathway (I) is proposed mainly for pi-ADH but can be catalyzed by HADH. However, Step 3 is catalyzed approximately 2 orders of magnitude more slowly by HADH than by pi-ADH. This conclusion is confirmed by the results, which indicate that pi-ADH very efficiently catalyzes the reduction of BQI and 1,4-benzoquinone (BQ) to the corresponding hydroquinones. The kinetic constants determined at pH 7.4 suggest that pi-ADH is a more efficient quinone reductase and nitroso reductase than it is an ethanol oxidase or acetaldehyde reductase. An alternative mechanism of pNSP reduction, shown by Equation 2, is suggested for HADH. In this mechanism, formation of the p-hydroxybenzylnitrenium ion (pNH+P) occurs at the active-site zinc ion of the enzyme (Step 2) and accelerates further nonenzymatic reduction to pAP or hydrolysis to BQ (Step 3). [formula: see text]     

Anticardiolipin antibody-associated cerebral infarction in cirrhosis: clearance of anticardiolipin antibody after liver transplantation

We report a 47-yr-old woman with a 30-yr history of cryptogenic cirrhosis who sustained a cerebral infarction shortly before undergoing liver transplantation. Anticardiolipin antibody titers were positive prior to transplantation (IgG = 24 GPL; IgM > 80 MPL; IgA < 10 APL). After liver transplantation, however, the titers dropped to normal (< 10 PL units). This report suggests that cirrhotic patients with high anticardiolipin antibody titers may be at risk for thrombotic events, and that this tendency may be reversed by liver transplantation or post-transplant immunosuppressive agents.     

Endurance exercise training improves body composition and plasma insulin responses in 70- to 79-year-old men and women

Forty-two men and women aged 70 to 79 years were studied to assess the effects of 6 months of endurance or resistance training and subsequent cessation of training on glucose tolerance, plasma insulin responses, serum triglyceride and cholesterol levels, and plasma dehydroepiandrosterone (DHEA) levels. The endurance training group (n = 16) exercised at 75% to 85% heart rate reserve for 35 to 45 minutes three times per week; the resistance training group (n = 17) completed one set of eight to 12 repetitions on 10 Nautilus machines three times per week. No significant changes in any variables occurred in a control group (n = 9). Maximal oxygen consumption (VO2max) increased by 20% with endurance training, but did not change with resistance training. Upper- and lower-body strength increased in the resistance training group, but did not change with endurance training. Neither group changed their body weight with training, but the endurance training group elicited a significant reduction in their sum of seven skinfolds and percent body fat. Neither group altered their glucose tolerance with training; however, the endurance training group had lower plasma insulin responses after training compared with the other two groups. Serum lipid and plasma DHEA levels did not change in either the endurance or resistance training groups. Ten days of no exercise following training did not significantly alter body weight or composition, glucose tolerance, plasma insulin responses, or plasma DHEA levels in either the endurance training (n = 10) or resistance training (n = 14) group.(ABSTRACT TRUNCATED AT 250 WORDS)     

The effects of Alzheimer disease on driving-related abilities

Ten Alzheimer disease (AD) patients and 12 healthy elderly controls were evaluated on two tests of driving-related abilities: the Driver Performance Test (DPT) and the Driving Advisement System (DAS). Subjects were administered a battery of neuropsychological tests to determine if severity of dementia in AD correlates with driving performance. On the DPT, the AD patients scored in the average range in two of five skill areas (predicting the effects of a hazard, deciding how to avoid it); below average in two areas (searching for a hazard, executing evasive actions); and poorly in one area (identifying hazards). The elderly controls scored at an average level in all five skill areas. On the DAS, AD patients were significantly slower than the elderly controls on simple, two-choice, and conditional reaction time tests and were much slower than drivers in general. The AD patients' performances on two cognitive tests, the Mini-Mental State Examination (MMSE) and the Category Fluency Test, correlated significantly with aspects of performance on the DPT and the DAS. Although these are preliminary results from a pilot investigation, they suggest that AD patients' driving-related abilities are adversely affected by the disease and that driving-related performance tests and neuropsychological tests may be useful in assessing the impact of AD on driving.